In the public forum of his website, Dr. Edzard Ernst recently made a startling claim. Dr. Ernst is an outspoken critic of cervical spine manipulation and the chiropractic profession. Dr. Ernst was reacting to this statement from a study I published in the Cureus Journal of Medical Science:

“Research does not support a causal association between cervical spine manipulation (CSM) and cervical artery dissection (CAD).”1

In a comment to his public forum post, Dr. Ernst stated,

“’Research does not support a causal association between cervical spine manipulation (CSM) and cervical artery dissection (CAD)’ claim chiros, while almost the rest of the world knows that research does support a causal association between cervical spine manipulation (CSM) and cervical artery dissection (CAD).”

Who is correct? The ones who earn their living through CSM, or the ones who weight the evidence more objectively?”2 Dr. Ernst is claiming that only “chiros” claim that research does not support a causal association between CSM and CAD. In my Cureus study. I cited two references to support my statement.

These two references demonstrate that Dr. Ernst is incorrect. It is not only “chiros” that claim that research does not support a causal association between CSM and CAD:

Church, et al. (2016)

“There is no convincing evidence to support a causal link between chiropractic manipulation and CAD.”3 This conclusion is from a 2016 study published in the Cureus Journal of Medical Science by six neurosurgeons from the Department of Neurosurgery at Penn State Hershey Medical Center.

No “chiros” were involved in this study. The study was not published in a chiropractic journal. None of the authors of this study earns their living through CSM. The authors weighed the evidence objectively and this was their conclusion.

Biller, et al. (2014)

The authors of this study state that the biomechanical evidence is insufficient to establish the claim that CSM causes CAD, and recommends that practitioners should strongly consider the possibility of CAD as a presenting symptom.4 This comes from a 2014 study published in Stroke by 11 MDs and one “chiro” on behalf of the American Heart Association Stroke Council and endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons.

Only one “chiro” was involved in this study. The study was not published in a chiropractic journal. At least 11 authors of this study do not earn their living through CSM. The authors weighed the evidence objectively and these were their findings.

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Running the Risk of Irrelevancy

Dr. Ernst is not alone in his denial and/or ignorance of the research. In their 2016 study, Church, et al., noted,

“In spite of the very weak data supporting an association between chiropractic neck manipulation and CAD, and even more modest data supporting a causal association, such a relationship is assumed by many clinicians. In fact, this idea seems to enjoy the status of medical dogma. Excellent peer reviewed publications frequently contain statements asserting a causal relationship between cervical manipulation and CAD.”3

It is my opinion that Dr. Ernst, and others with similar views, run the risk of becoming irrelevant to the discussion as they refuse to accept the reality of the research. I agree with Church, et al., when they state,

“We suggest that physicians should exercise caution in ascribing causation to associations in the absence of adequate and reliable data. Medical history offers many examples of relationships that were initially falsely assumed to be causal, and the relationship between CAD and chiropractic neck manipulation may need to be added to this list.”3

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References

1. Brown SP. Cervical spine manipulation and causation of cervical artery dissection: a review of 10 case reports. Cureus, 2024 Jun;16(6):e62845.
2. Ernst E. "Cervical Spine Manipulation and Cervical Artery Dissection: An Embarrassingly Daft Attempt of a White-Wash." Edzard Ernst Forum (internet), 2024 [cited 2024 Jul 2]. Available here.
3. Church EW, Sieg EP, Zalatimo O, et al. Systematic review and meta-analysis of chiropractic care and cervical artery dissection: no evidence for causation. Cureus, 2016 Feb 16;8(2):e498.
4. Biller J, Sacco RL, Albuquerque FC, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association / American Stroke Association. Stroke, 2014 Oct;45(10):3155-74.